Provider Demographics
NPI:1841862323
Name:FUNDAMENTAL FOUNDATIONS COUNSELING CENTER, PLLC
Entity type:Organization
Organization Name:FUNDAMENTAL FOUNDATIONS COUNSELING CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHAHIDRAH
Authorized Official - Middle Name:R
Authorized Official - Last Name:COWGILL
Authorized Official - Suffix:
Authorized Official - Credentials:LPC-S
Authorized Official - Phone:214-475-0345
Mailing Address - Street 1:2601 LITTLE ELM PKWY STE 302
Mailing Address - Street 2:
Mailing Address - City:LITTLE ELM
Mailing Address - State:TX
Mailing Address - Zip Code:75068-1919
Mailing Address - Country:US
Mailing Address - Phone:214-475-0345
Mailing Address - Fax:214-935-3302
Practice Address - Street 1:2601 LITTLE ELM PKWY STE 302
Practice Address - Street 2:
Practice Address - City:LITTLE ELM
Practice Address - State:TX
Practice Address - Zip Code:75068-1919
Practice Address - Country:US
Practice Address - Phone:214-475-0345
Practice Address - Fax:214-935-3302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-14
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental HealthGroup - Multi-Specialty